The burden of cough and phlegm in people with COPD: A COPD patient-powered research network study

Radmila Choate, Cara B. Pasquale, Nereida A. Parada, Valentin Prieto-Centurion, Richard A. Mularski, Barbara P. Yawn

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Rationale: Cough and phlegm are common symptoms of chronic obstructive pulmonary disease (COPD) and may significantly affect quality of life. This study assessed the burden of cough and phlegm on clinical outcomes and quality of life among people with a self-reported physician diagnosis of COPD. Methods: Patient-reported data from the COPD Foundation's Patient-Powered Research Network (COPD PPRN) were utilized. Cough and phlegm severity and frequency were assessed by responses to questions on the COPD Assessment Test (CAT) and categorized into none/low, moderate and severe. Quality of life domains were evaluated using the Patient-Reported Outcome Measurement Information System (PROMIS-29). Associations between cough and phlegm levels and PROMIS-29 domains were examined using multivariate analysis of variance (MANOVA). Results: The 5286 participants were average age 64.4 years (SD=11.4), 87.9% white, 60.4% female, 51.2% married, and 42.2% with caregivers. Approximately three-fourths of the participants had moderate or severe cough or phlegm levels. Respondents with moderate and high cough or phlegm had significantly worse dyspnea (p<0.0001), more exacerbations in the previous one year (p<0.0001), worse physical and social functioning, and more symptoms of anxiety and depression on PROMIS-29 compared to those with no/low cough and phlegm. Conclusions: In this group of people with COPD, higher levels of cough and phlegm are associated with worse clinical and quality of life outcomes.

Original languageEnglish
Pages (from-to)49-59
Number of pages11
JournalChronic Obstructive Pulmonary Diseases
Issue number1
StatePublished - 2020

Bibliographical note

Funding Information:
Abbreviations: chronic obstructive pulmonary disease, COPD; COPD Patient-Powered Research Network, COPD-PPRN; Patient-Reported Outcome Measurement Information System, PROMIS-29; multivariate analysis of variance, MANOVA; emergency department, ED; health-related quality of life, HRQoL; patient-reported outcomes, PROs; Patient-Centered Outcomes Research Institute, PCORI; modified Medical Research Council, mMRC; Charlson Age-Comorbidity Index, CACI; standard deviation, SD; analysis of variance, ANOVA; Kendall’s tau-b, τb; Global initiative for chronic Obstructive Lung Disease, GOLD Funding Support: This study was funded through a Patient-Centered Outcomes Research Institute® (PCORI®) Award (PPRN-1306-04748 Phase II) for the development of the National Patient-Centered Clinical Research Network, known as PCORnet® and through the COPD Foundation, Washington, DC. The statements presented in this article are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute® (PCORI®), its Board of Governors or Methodology Committee or other participants in PCORnet®. Date of Acceptance: December 19, 2019 Citation: Choate R, Pasquale CB, Parada NA, Prieto-Centurion V, Mularski RA, Yawn BP. The burden of cough and phlegm in people with COPD: a COPD Patient-Powered Research Network study. Chronic Obstr Pulm Dis. 2020;7(1):49-59. doi: jcopdf.7.1.2019.0146

Funding Information:
Our study used PROs data collected from individuals with self-reported physician diagnoses of COPD who are enrolled in the COPD PPRN. This study utilized data from the COPD PPRN Registry established in 2013, maintained by the COPD Foundation and funded by the Patient-Centered Outcomes Research Institute (PCORI) and the Foundation. This online patient research registry has over 7700 consented adults with self-reported COPD enrolled nationally. Each enrolled individual completed baseline surveys querying them about their COPD, presence of comorbid conditions including diabetes, cardiovascular disease and co- existing lung diseases (asthma, bronchiectasis), and COPD exacerbation occurrence as well as completing the COPD Assessment Test (CAT) and the Patient Reported Outcome Measurement Information System (PROMIS-29) that covers emotional, physical and social role functioning. Each PPRN member has an account on a secure platform where they provided electronic consent agreeing to be informed of additional PPRN-sponsored surveys, facilitated by a personalized dashboard. Eligibility criteria for COPD PPRN membership includes being a U.S. resident, 18 years or older and having a self-reported physician diagnosis of COPD/chronic bronchitis/emphysema. The data for this study were taken from the baseline CAT completed at the time of enrollment.

Publisher Copyright:
© 2020 COPD Foundation. All rights reserved.

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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